Provider Demographics
NPI:1457387417
Name:YAMAMOTO, ALFRED MITSURU (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:MITSURU
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2374 E PACIFICA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6214
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7054
Practice Address - Street 1:3700 SOUTH ST
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1419
Practice Address - Country:US
Practice Address - Phone:562-602-6737
Practice Address - Fax:562-602-6896
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61896207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G618960Medicaid
CAF09675Medicare UPIN
CAWG61896HMedicare PIN
CA00G618960Medicaid
CAWG61896BMedicare PIN
CAWG61896GMedicare PIN